MEDICARE: ELMER F. BAYSA MD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD-4889	HI

General Provider Information

NPI Number	:	1619456035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMER F. BAYSA MD, INC

Provider Business Mailing Address
First Line	:	91-775 PAPIPI RD STE A
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2466
Country	:	US
Telephone Number	:	808-689-8315
Fax Number	:	808-689-8153

Provider Business Practice Location Address
First Line	:	91-775 PAPIPI RD STE A
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2466
Country	:	US
Telephone Number	:	808-689-8315
Fax Number	:	808-689-8153

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MALIA VALENCIA
Credential	:
Telephone Number	:	808-689-8315

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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